In Reply

We appreciate Monteset al.’s interest in our article. In their 2015 Anesthesiology article, the authors analyzed data from 2,929 patients who were candidates for inguinal hernia repair (men), hysterectomy (women), or thoracotomy (men) under general, regional, or local anesthesia with sedation. Four hundred and two patients (all male) underwent thoracotomy.1 Approximately 4.4 months after surgery, 37.6% of the thoracotomy patients had chronic postsurgical pain. We think the size of the study —nearly 3,000 patients enrolled—is quite remarkable.

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CONCLUSION: Surgeons must work with the implant that best suits their patients' needs and that also provides good results and adequate working comfort. The PUMP technique performs well for ventral hernias sized between 2 and 4 cm without the need of midline reconstruction due to diastasis of the rectus muscles. It enables a local extraperitoneal mesh augmentation without the risk of intraperitoneal complications. PUMP repair lowers the risk of recurrence in comparison with suture repair without increasing the risk of complications.
PMID: 31394581 [PubMed - as supplied by publisher]

ConclusionPRO assessments and meaningful communications between the physician and the patient can provide a comprehensive benefit –risk assessment prior to surgery, and may also improve patient understanding of what to expect during recovery from surgery.

This study is a retrospective analysis of a prospectively maintained database of all patients with groin hernia who underwent TEP repair in a single surgical unit between January 2004 and January 2018. Patients’ demographic profile and hernia characteristics (duration, side, extent, content, and reducibility) were noted in the prestructured proforma. Clinical outcomes included the operation time, intraoperative and postoperative complications, length of postoperative hospital stay, hernia recurrence, chronic pain, recurrence, seroma, and wound infections. Long-term follow-up was carried out in the outpatient departme...

Conclusions:
The present work demonstrates higher incidence of postoperative scrotal hematoma after TEP repair in patients with history of previous lower abdominal surgery. All remaining outcomes of interest were found to be similar between the 2 patient groups. Further trials will be needed to verify our findings.

Dr Michael S. Nussbaum (Roanoke, VA): This excellent review of a prospectively collected hernia database aimed to evaluate the safety, efficacy, and efficiency of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with prior prostatectomy compared with matched controls without prior prostatectomy as well as post prostatectomy patients who underwent open inguinal hernia repair. Although operative duration was longer in the prostatectomy group and there were more peritoneal tears, the length of stay, return to activity, complications, rate of recurrence and chronic pain were equivalent.

Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for perioperative complications. The frequency of complications depends on the severity of COPD, the type of anesthesia used, the surgical site, and other comorbidities. Patients undergoing upper abdominal surgery have significant changes in lung volumes, likely secondary to changes in diaphragm function and abdominal pain, and these changes increase the risk for complications, including acute respiratory failure, atelectasis, pneumonia and unplanned reintubation. We discuss a patient with COPD who did well for the first 3 da...

ConclusionInguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.

ConclusionIn a selected patient collective with small and lateral incisional hernias and with a large proportion of women, outcomes obtained for the onlay and sublay techniques do not differ significantly.

ConclusionThe use of self-gripping mesh with ACS can be performed without increasing the operative time or causing short-term surgical complications. This technique may be recommended for large IH because of its simplicity and secure abdominal reinforcement provided.